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Alteplase and Acute Ishemic Stroke - #PHARMFAX

Alteplase decreases disability at 90 days by 28% for acute ischemic stroke (AIS) with a 6% risk of symptomatic hemorrhage.

 

Alteplase decreases disability at 90 days by 28% for acute ischemic stroke (AIS) with a 6% risk of symptomatic hemorrhage. Also known as the clot buster, it’s used for AIS, pulmonary embolisms (PE), and heart attacks (STEMI). As a potent thrombolytic that binds to fibrin, inducing fibrinolysis and clot breakdown.


The half life is around 5 minutes and fibrinolysis activity can last up to an hour after terminating the infusion. Review the AHA tPA inclusion and exclusion criteria, and consider stroke mimics, such as hypoglycemia and migraines.


Alteplase can cause angioedema in 1 of 8 patients. Standard anaphylaxis therapy is recommended, but EPI via inhalation or subcutaneous can be considered given the risk of bleeding with abrupt increase in BP.


For life-theatening bleeds from alteplase, start cryptopreciptate 10 units and then PRN to maintain a fibrinogen level greater than 150. Tranexamic acid is a fibrinolytic agent that will help with hemostasis. From there, its a matter of ICP management and indications for neurosurgery. Did you check the PHARMFAX? Visit my website, pharmwyze.com


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Not medical advice. Educational purposes only. No relationships to report. I hope you learned something new.

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